Let our specialists resolve difficult issues on your employees’ behalf, freeing resources and protecting your HR team.
Putting Trusted Advocates In Place
Navigating the world of healthcare claims, networks, referrals and deductibles takes special knowledge – often overwhelming employees and their family and leaving HR departments with more than they can or should support. That’s why we’ve created the Benefit Advocacy program to give your company crucial resources to serve employees and make sure they are satisfied. The program provides individuals and families with a personal Advocate Team to coordinate, research and support the employee’s specific needs. To help get answers and/or resolve difficult issues, our specialists work one on one with your employees as well as with your HR professionals. It’s just one more example of how we always seek to find a better way.
Adding Depth To Your Benefits Package
The Member Advocacy program encompasses three ways of improving your healthcare benefits offerings:
Member Advocacy – when employees or their family members have issues with the health plan who helps them?
We provide support in situations where your insurance company or plan administrators are unable to resolve issues on behalf of employees or their dependents.
Member Outreach- When members are calling the carrier repeatedly for assistance, does anyone know or follow up?
We proactively reach out to members that have had multiple claims or numerous contact with the insurance company or health plan administrator.
Benefit Exception Determination – when your plan document doesn’t address a service or treatment, who determines if it should be considered?
Within defined limits and coverages, we determine benefit exceptions and/or make benefit determinations where either the Plan Document does not provide clarity or the Plan or member is better served. Plus we can insure uniformity of future benefit administration. Regardless of who is administering your plan, we can work with you.
Immediate Benefits For Your Client’s Employees
Your client’s can expect to reap the following advantages from taking part in the Member Advocacy program:
- Minimize or eliminate exposure to HIPPA related privacy issues
- Quicker resolution of problem claims thanks to your ability to speak the carrier’s language
- Cost and time savings as both employees and HR professionals are relieved of navigating the healthcare system
- Expansion of resources and talent focus on maximizing employee benefits
- Increased employee satisfaction and appreciation for their benefit plan and the assistance they receive via the human resources department
- Efficient reporting as we track, report and analyze issues impacting the plan. Gathering data from carriers and being able to measure – Measuring of the health plans by using the reporting
- Improved quality of care as our Member Advocates investigate and, when appropriate, resolve medical necessity issues
From The Specialists You Can Trust
No company is better regarded for helping companies and associations with healthcare plan administration than AmWINS Group Benefits. And WEB-TPA, which administers the Healthcare Advocacy program, is well known as a leading third-party administrator focused on improving the administration process for self-funded employers and insurance companies. Everything we do is dedicated to making life simpler for patients, providers and payers.